术中自体血液回收的风险
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摘要
血液保护技术能减少术中同种异体血的输注,节约宝贵的血源,并避免异体输血相关风险,因此,在围手术期的应用越来越广泛。但术中回收式自体血回输也有不良反应和并发症。本文综述其禁忌证、潜在风险及并发症,增强认知,提高麻醉中实施自体血回输的安全与质控,保障患者安全。
Blood salvage during surgery is used to reduce patient exposure to allogeneic blood,save the limited blood resources and avoid the risks related to allogeneic blood transfusion. With the wider use during surgery,we should target that intraoperative blood salvage has contraindications and complications. This paper summarizes the contraindications,latent risks and complications,aiming to raise the awareness,enhance the safety and quality control of blood salvage during surgery and ensure the safety of patients.
Blood salvage during surgery is used to reduce patient exposure to allogeneic blood,save the limited blood resources and avoid the risks related to allogeneic blood transfusion. With the wider use during surgery,we should target that intraoperative blood salvage has contraindications and complications. This paper summarizes the contraindications,latent risks and complications,aiming to raise the awareness,enhance the safety and quality control of blood salvage during surgery and ensure the safety of patients.
引文
[1]ESPER S A,WATERS J H.Intra-operative cell salvage:a fresh look at the indications and contraindications[J].Blood Transfus,2011,9(2):139-147.DOI:10.2450/2011.0081-10.
[2]WATERS J H.Intraoperative blood recovery[J].ASAIO J,2013,59(1):11-17.DOI:10.1097/MAT.0b013e31827b5187.
[3]TIMBERLAKE G A,MCSWAIN N J.Autotransfusion of blood contaminated by enteric contents:a potentially life-saving measure in the massively hemorrhaging trauma patient?[J].J Trauma,1988,28(6):855-857.
[4]LI J,SUN S L,TIAN J H,et al.Cell salvage in emergency trauma surgery[J].Cochrane Database Syst Rev,2015,1:D7379.DOI:10.1002/14651858.CD007379.pub2.
[5]WATERS J H,TUOHY M J,HOBSON D F,et al.Bacterial reduction by cell salvage washing and leukocyte depletion filtration[J].Anesthesiology,2003,99(3):652-655.
[6]KUMAR N,LAM R,ZAW A S,et al.Flow cytometric evaluation of the safety of intraoperative salvaged blood filtered with leucocyte depletion filter in spine tumour surgery[J].Ann Surg Oncol,2014,21(13):4330-4335.DOI:10.1245/s10434-014-3950-9.
[7]KUMAR N,CHEN Y,ZAW A S,et al.Use of intraoperative cellsalvage for autologous blood transfusions in metastatic spine tumour surgery:a systematic review[J].Lancet Oncol,2014,15(1):e33-e41.DOI:10.1016/S1470-2045(13)70245-6.
[8]KUMAR N,AHMED Q,LEE V K,et al.Can there be a place for intraoperative salvaged blood in spine tumor surgery?[J].Ann Surg Oncol,2014,21(7):2436-2443.DOI:10.1245/s10434-014-3569-x.
[9]CATLING S,WILLIAMS S,FREITES O,et al.Use of a leucocyte filter to remove tumour cells from intra-operative cell salvage blood[J].Anaesthesia,2008,63(12):1332-1338.DOI:10.1111/j.1365-2044.2008.05637.x.
[10]PERSEGHIN P,VIGANM,ROCCO G,et al.Effectiveness of leukocyte filters in reducing tumor cell contamination after intraoperative blood salvage in lung cancer patients[J].Vox Sang,1997,72(4):221-224.
[11]WATERS J H,YAZER M,CHEN Y F,et al.Blood salvage and cancer surgery:a meta-analysis of available studies[J].Transfusion,2012,52(10):2167-2173.DOI:10.1111/j.1537-2995.2011.03555.x.
[12]Committee on Obstetric Practice.Committee opinion no.529:placenta accreta[J].Obstet Gynecol,2012,120(1):207-211.DOI:10.1097/AOG.0b013e318262e340.
[13]MILNE M E,YAZER M H,WATERS J H.Red blood cell salvage during obstetric hemorrhage[J].Obstet Gynecol,2015,125(4):919-923.DOI:10.1097/AOG.0000000000000729.
[14]SMITH D F,MIHM F G,MEFFORD I.Hypertension after intraoperative autotransfusion in bilateral adrenalectomy for pheochromocytoma[J].Anesthesiology,1983,58(2):182-184.
[15]GABEL J,MALM C J,RADULOVIC V,et al.Cell saver processing mitigates the negative effects of wound blood on platelet function[J].Acta Anaesthesiol Scand,2016,60(7):901-909.DOI:10.1111/aas.12730.
[16]HANSEN E,HANSEN M P.Reasons against the retransfusion of unwashed wound blood[J].Transfusion,2004,44(12 Suppl):45S-53S.DOI:10.1111/j.0041-1132.2004.04179.x.
[17]Practice guidelines for perioperative blood management:an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*[J].Anesthesiology,2015,122(2):241-275.DOI:10.1097/ALN.0000000000000463.
[18]ASHWORTH A,KLEIN A A.Cell salvage as part of a blood conservation strategy in anaesthesia[J].Br J Anaesth,2010,105(4):401-416.DOI:10.1093/bja/aeq244.
[19]LINDEN J V,KAPLAN H S,MURPHY M T.Fatal air embolism due to perioperative blood recovery[J].Anesth Analg,1997,84(2):422-426.
[20]KONIG G,WATERS J H.Washing and filtering of cell-salvaged blood-does it make autotransfusion safer?[J].Transfus Altern Transfus Med,2012,12(3/4):78-87.DOI:10.1111/j.1778-428X.2012.01155.x.
[2]WATERS J H.Intraoperative blood recovery[J].ASAIO J,2013,59(1):11-17.DOI:10.1097/MAT.0b013e31827b5187.
[3]TIMBERLAKE G A,MCSWAIN N J.Autotransfusion of blood contaminated by enteric contents:a potentially life-saving measure in the massively hemorrhaging trauma patient?[J].J Trauma,1988,28(6):855-857.
[4]LI J,SUN S L,TIAN J H,et al.Cell salvage in emergency trauma surgery[J].Cochrane Database Syst Rev,2015,1:D7379.DOI:10.1002/14651858.CD007379.pub2.
[5]WATERS J H,TUOHY M J,HOBSON D F,et al.Bacterial reduction by cell salvage washing and leukocyte depletion filtration[J].Anesthesiology,2003,99(3):652-655.
[6]KUMAR N,LAM R,ZAW A S,et al.Flow cytometric evaluation of the safety of intraoperative salvaged blood filtered with leucocyte depletion filter in spine tumour surgery[J].Ann Surg Oncol,2014,21(13):4330-4335.DOI:10.1245/s10434-014-3950-9.
[7]KUMAR N,CHEN Y,ZAW A S,et al.Use of intraoperative cellsalvage for autologous blood transfusions in metastatic spine tumour surgery:a systematic review[J].Lancet Oncol,2014,15(1):e33-e41.DOI:10.1016/S1470-2045(13)70245-6.
[8]KUMAR N,AHMED Q,LEE V K,et al.Can there be a place for intraoperative salvaged blood in spine tumor surgery?[J].Ann Surg Oncol,2014,21(7):2436-2443.DOI:10.1245/s10434-014-3569-x.
[9]CATLING S,WILLIAMS S,FREITES O,et al.Use of a leucocyte filter to remove tumour cells from intra-operative cell salvage blood[J].Anaesthesia,2008,63(12):1332-1338.DOI:10.1111/j.1365-2044.2008.05637.x.
[10]PERSEGHIN P,VIGANM,ROCCO G,et al.Effectiveness of leukocyte filters in reducing tumor cell contamination after intraoperative blood salvage in lung cancer patients[J].Vox Sang,1997,72(4):221-224.
[11]WATERS J H,YAZER M,CHEN Y F,et al.Blood salvage and cancer surgery:a meta-analysis of available studies[J].Transfusion,2012,52(10):2167-2173.DOI:10.1111/j.1537-2995.2011.03555.x.
[12]Committee on Obstetric Practice.Committee opinion no.529:placenta accreta[J].Obstet Gynecol,2012,120(1):207-211.DOI:10.1097/AOG.0b013e318262e340.
[13]MILNE M E,YAZER M H,WATERS J H.Red blood cell salvage during obstetric hemorrhage[J].Obstet Gynecol,2015,125(4):919-923.DOI:10.1097/AOG.0000000000000729.
[14]SMITH D F,MIHM F G,MEFFORD I.Hypertension after intraoperative autotransfusion in bilateral adrenalectomy for pheochromocytoma[J].Anesthesiology,1983,58(2):182-184.
[15]GABEL J,MALM C J,RADULOVIC V,et al.Cell saver processing mitigates the negative effects of wound blood on platelet function[J].Acta Anaesthesiol Scand,2016,60(7):901-909.DOI:10.1111/aas.12730.
[16]HANSEN E,HANSEN M P.Reasons against the retransfusion of unwashed wound blood[J].Transfusion,2004,44(12 Suppl):45S-53S.DOI:10.1111/j.0041-1132.2004.04179.x.
[17]Practice guidelines for perioperative blood management:an updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management*[J].Anesthesiology,2015,122(2):241-275.DOI:10.1097/ALN.0000000000000463.
[18]ASHWORTH A,KLEIN A A.Cell salvage as part of a blood conservation strategy in anaesthesia[J].Br J Anaesth,2010,105(4):401-416.DOI:10.1093/bja/aeq244.
[19]LINDEN J V,KAPLAN H S,MURPHY M T.Fatal air embolism due to perioperative blood recovery[J].Anesth Analg,1997,84(2):422-426.
[20]KONIG G,WATERS J H.Washing and filtering of cell-salvaged blood-does it make autotransfusion safer?[J].Transfus Altern Transfus Med,2012,12(3/4):78-87.DOI:10.1111/j.1778-428X.2012.01155.x.